Assessment

Repeated multidisciplinary assessment should assess the ongoing need for cuff inflation and the presence of the tracheostomy itself. As soon as the tracheostomy tube is no longer required, it should be removed.

Sometimes the tube may be 'downsized' or changed for a minitrach. This maintains the patency of the stoma tract whilst allowing suction or oxygen to be administered if required. In some circumstances, the tube may simply be removed.

Question: What do you think are the prerequisites for tube removal (decannulation)?

Answer

Repeated multidisciplinary assessment should assess the ongoing need for cuff inflation and the presence of the tracheostomy itself. As soon as the tracheostomy tube is no longer required, it should be removed.

Sometimes the tube may be 'downsized' or changed for a minitrach. This maintains the patency of the stoma tract whilst allowing suction or oxygen to be administered if required. In some circumstances, the tube may simply be removed.

Question: What do you think are the prerequisites for tube removal (decannulation)?

Pre-requisites for tube removal (decannulation)

The patient:

  • Can maintain and protect their airway spontaneously
  • Is free from ventilatory support, although decannulation to allow non-invasive ventilation (NIV) can be used in some situations
  • Shows no sign of fever or active infection
  • Is consistently alert
  • Has a strong consistent cough (able to cough into mouth)
  • Has control of saliva
  • Is not scheduled for procedures requiring anaesthesia within the next few days
  • Is considered stable

Fig 1 is a video demonstrating the removal of sutures and ties, then decannulation. The stoma needs to be occluded following removal of the tube to enable ventilation and breathing via the upper airways.

Repeated multidisciplinary assessment should assess the ongoing need for cuff inflation and the presence of the tracheostomy itself. As soon as the tracheostomy tube is no longer required, it should be removed.

Sometimes the tube may be 'downsized' or changed for a minitrach. This maintains the patency of the stoma tract whilst allowing suction or oxygen to be administered if required. In some circumstances, the tube may simply be removed.

Question: What do you think are the prerequisites for tube removal (decannulation)?

Answer

Fig 1 Decannulation